Please download our Book, entitled, “Can You Dance The 5-Step” for a complete discussion about what is involved in determining whether a Claimant is disabled under SSA regulations. However, generally, under the Social Security Act, “disability” means “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or has lasted or can be expected to last for a continuous period of not less than 12 months.”
Although there are a number of programs for Social Security Disability benefits, the two primary programs are Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). SSDI is essentially an insurance program which provides disability benefits for those persons who have paid their “premiums” through payroll withholdings during the time of their working life, who have worked for a sufficient time, and who become disabled while they are insured. Their benefit amount is determined with reference to the amounts that they paid into the social security system. SSI is essentially a financial hardship program and does not depend upon prior work history or amounts paid into the system. SSI has substantial financial limits in its qualifications, including limits on monthly income and in assets of the Claimant. The amount of the benefit is established by the federal and state government with maximum limits that change annually. Both programs require that the Claimant be Disabled, and both follow the same procedure for determining whether a Claimant meets the definition above for disability.
Usually a Claimant will go to the Social Security office, in person, and meet with a Claim Representative. During that interview, the Claimant will provide information including prior work history and medical information, to enable the process of gathering supporting information to begin. You may also contact the SSA by phone, or complete an application online at the website for SSA, www.ssa.gov. If you use an attorney, the attorney CANNOT sign your application for you.
No. There is no waiting period, and you may file as soon as you become disabled. Although you may not be aware, when you become disabled, of how long your disability may last (as SSA requires that it last for 12 months in order to qualify) there is no problem with filing early, since the process for determining disability may take many months. If you have suffered a severe and permanent injury, or are diagnosed with a medical condition that is expected to be permanent or fatal, do not hesitate to file your claim for disability immediately.
Yes you can, however there are limits that are placed on your benefits to avoid you received double compensation. The Social Security benefits will be reduced or offset, by the amount of the worker’s compensation benefits, so that you will not end up receiving more than a set percentage of your prior average weekly wages. The offset differs from state to state.
The determination of disability is made either by the Disability Determination Services agency of your state, or by and Administrative Law Judge at the SSA level. There a multitude of factors that go into the disability determination, and you cannot predict whether you will be determined to qualify. There are certain catastrophic medical conditions that may make it highly likely that you will be found to be disabled, however it is best to discuss your individual case with a social security disability lawyer, such as those atEpstein, Sandler & Flora, PC. to get an understanding of what will be needed to be proven in your case.
Even though you file your case with the Social Security Administration, at a local office, all cases are referred to the state Disability Determination Services agency (DDS). It is their job to gather the medical evidence from your doctors and your prior work information. They will, in the SSDI cases, obtain your prior payment information to make sure you are “insured”, and they will make the initial decision, using medical and non-medical personnel, about your disability. If your claim is denied, then the case, will be Reconsidered by different personnel at the same agency. If your claim is still denied, you may request a hearing before an Administrative Law Judge. It is at this level that SSA personnel review the case and make a decision on disability. This is the only review where you actually get to see, hear and speak to the person making the decision in your case.
In SSDI cases, you cannot receive benefits for the first 5 months after you become disabled. This is referred to as your waiting period. Also, benefits cannot be paid back any further than one year before the date that you filed your claim. In SSI cases, you will receive benefits commencing with the date of your application, but not before, even if your disability started before you filed your application for benefits.
The time that it takes to receive a final favorable determination depends upon the location in the country as there are backlogs that vary. The average time for a decision on the initial application can be 3-6 months. The average time for a decision at the Reconsideration level can be 2-4 months. The average time between filing an appeal to the Administrative Law Judge, and the actual hearing can range from 9-18 months, and in some areas, 2 years. The SSA is continuously trying to address the backlog issue.
The hearings are fairly informal. The only people likely to be there are the judge, a secretary operating a tape recorder, the claimant, the claimant’s attorney, and anyone else the claimant has brought with him or her. In some cases, the Administrative Law Judge has a medical doctor or vocational expert present to testify at the hearing. There is no jury nor are there any spectators at the hearing. There is no attorney at the hearing representing Social Security trying to get the judge to deny the disability claim.
No. The process of claim review at the stages of the initial application and the Reconsideration rarely involve an attorney, as you have little input in the decision process. While you do not have to have an attorney at the hearing stage, statistically you are likely to have a better chance at a favorable result, when an attorney is involved to gather and present evidence, with an understanding of the issues to be determined by the Administrative Law Judge.
Social Security’s position is that it is not up to your doctor to determine whether or not you are disabled. Disability is not entirely a medical determination, as it is based upon how your limitations affect your ability to work. The SSA and the ALJ make the determination of whether you are disabled.
No. There are no percentages of disability in Social Security disability determination. For purposes of Social Security disability benefits, you are either disabled or not disabled. There are no percentages of disability, nor any percentages of disability benefits.
Yes. Mental illness is a frequent basis for awarding Social Security disability benefits. In addition, emotional or mental impairments may, when coupled with physical limitations, may qualify for disability.
No. When you reach full retirement age, nothing will change, except for Social Security purposes, your benefits will be called retirement benefits instead of disability benefits.